Mediating role of homebound status between depressive symptoms and cognitive impairment among community-dwelling older adults in the USA: a cross-sectional analysis of a cohort study.
Mediating role of homebound status between depressive symptoms and cognitive impairment among community-dwelling older adults in the USA: a cross-sectional analysis of a cohort study.
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DOI：
10.1136/bmjopen-2022-065536
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发表时间：
2022-10-31
期刊：
影响因子：
2.9
通讯作者：
中科院分区：
文献类型：
--
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抑郁症状是老年人认知障碍的已知可变因素。然而，抑郁症状导致认知障碍的途径还不清楚。本研究旨在调查居家状态（定义为通常无法在无人协助的情况下离开家）是否介导美国社区老年人的抑郁症状与认知障碍之间的关联。横截面数据的二次分析。美国的社区。社区居住老年人（N=7537）来自2011年全国健康和老龄化趋势研究，这是美国医疗保险受益人的全国代表性调查。参与者的认知障碍状态使用复合测量进行分类。使用患者健康问卷-2评估抑郁症状。居家状态由外出的频率、困难程度和需要帮助程度决定。我们使用logistic回归和STATA中的Paramed命令来分析是否在家介导抑郁症状和认知障碍之间的关联。参与者平均年龄为77.7岁，女性（58.3%）和非西班牙裔白色（68.1%）。大约26%的参与者被归类为认知障碍，16%的人报告有抑郁症状，25%的人在家。抑郁症状（校正OR，1.60; 95%CI 1.36 - 1.89）和居家状态（校正OR，1.58; 95%CI 1.34 - 1.86）与认知功能障碍独立相关。在抑郁症状和认知功能障碍之间，居家显著介导了12.5%的总效应，具有显著的间接效应（OR，1.07; 95%CI 1.04至1.10）、直接效应（OR，1.61; 95%CI 1.36至1.91）和总效应（OR，1.72; 95%CI 1.46至2.03）。本研究支持居家状态在抑郁症状与认知功能障碍之间的中介作用。应研究促进户外活动的干预措施是否能够延迟有抑郁症状的老年人的认知障碍。
Depressive symptoms are known modifiable factors of cognitive impairment in older adults. However, the pathway through which depressive symptoms lead to cognitive impairment is not well understood. This study aimed to investigate whether homebound status (defined as usually unable to leave home unassisted) mediates the association between depressive symptoms and cognitive impairment in community-dwelling older adults in the USA. A secondary analysis of cross-sectional data. Communities in the USA. Community-dwelling older adults (N=7537) from the 2011 National Health and Aging Trends Study, a nationally representative survey of Medicare Beneficiaries in the USA. Participants’ cognitive impairment status was classified using a composite measure. Depressive symptoms were assessed using Patient Health Questionnaire-2. Homebound status was determined by the frequency, difficulty and needing help in getting outdoors. We used logistic regression and the Paramed command in STATA to analyse whether homebound mediated the association between depressive symptoms and cognitive impairment. Participants were on average, 77.7 years old, female (58.3%) and non-Hispanic white (68.1%). About 26% of the participants were classified as having cognitive impairment, 16% reported depressive symptoms and 25% were homebound. Depressive symptoms (adjusted OR, 1.60; 95% CI 1.36 to 1.89) and homebound status (adjusted OR, 1.58; 95% CI 1.34 to 1.86) were independently associated with cognitive impairment. Homebound significantly mediated 12.5% of the total effect between depressive symptoms and cognitive impairment, with significant indirect effect (OR, 1.07; 95% CI 1.04 to 1.10), direct effect (OR, 1.61; 95% CI 1.36 to 1.91) and total effect (OR, 1.72; 95% CI 1.46 to 2.03). This study supports a mediating role of homebound status in the relationship between depressive symptoms and cognitive impairment. Interventions to promote outdoor mobility should be studied for their ability to delay cognitive impairment for older adults with depressive symptoms.
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